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Jia D, Wang H, Wang Q, Li W, Lan X, Zhou H, Zhang Z. Rapid shallow breathing index predicting extubation outcomes: A systematic review and meta-analysis. Intensive Crit Care Nurs 2024; 80:103551. [PMID: 37783181 DOI: 10.1016/j.iccn.2023.103551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE This meta-analysis aimed to assess the predictive value of the rapid shallow breathing index for extubation outcomes. METHODOLOGY We conducted a systematic review of literature (inception to March 2023) and a meta-analysis. Statistical analysis was performed using Meta-Disc 1.4 software, RevMan 5.4 software and Stata 14.0 software to evaluate the predictive value of RSBI for extubation outcomes. RESULTS A total of 1,987 studies were retrieved, and after applying the inclusion criteria, 79 studies were included in the final analysis, involving 13,170 patients undergoing mechanical ventilation. The random-effects model was employed for statistical analysis. The summary receiver operating characteristic curves (SROC) area under the curve (AUC) was 0.8144. The pooled sensitivity was 0.60 (95% CI: 0.59, 0.61), the pooled specificity was 0.68 (95% CI: 0.66, 0.70). CONCLUSIONS The Rapid Shallow Breathing Index demonstrated moderate accuracy, poor pooled sensitivity and specificity in predicting successful extubation, however the study does not present adequate data to support or reject the use of this tool as a single parameter that predicts extubation outcome. Future studies should explore the combination of The Rapid Shallow Breathing Index with other indicators and clinical experience to improve the success rate of extubation and reduce the risk of extubation failure. IMPLICATIONS FOR CLINICAL PRACTICE Premature and delayed extubation in mechanically ventilated patients can have a negative impact on prognosis and prolong hospital stay. The Rapid Shallow Breathing Index is a simple, cost-effective, and easily monitored objective evaluation index, which can be used to predict the outcome of extubation, especially in primary hospitals. Our study comprehensively evaluated the value of this tool in predicting extubation outcomes, which can help clinicians combine subjective experience with objective indicators to improve the accuracy of extubation time decisions.
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Affiliation(s)
- Donghui Jia
- Department of Critical Care Medicine, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, PR China; School of Nursing, Lanzhou University, Lanzhou, Gansu 730000, PR China
| | - Hengyang Wang
- Department of Critical Care Medicine, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, PR China; School of Nursing, Lanzhou University, Lanzhou, Gansu 730000, PR China
| | - Qian Wang
- Department of Critical Care Medicine, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, PR China; School of Nursing, Lanzhou University, Lanzhou, Gansu 730000, PR China
| | - Wenrui Li
- Department of Critical Care Medicine, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, PR China; School of Nursing, Lanzhou University, Lanzhou, Gansu 730000, PR China
| | - Xuhong Lan
- Department of Critical Care Medicine, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, PR China; School of Nursing, Lanzhou University, Lanzhou, Gansu 730000, PR China
| | - Hongfang Zhou
- Department of Critical Care Medicine, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, PR China; School of Nursing, Lanzhou University, Lanzhou, Gansu 730000, PR China
| | - Zhigang Zhang
- Department of Critical Care Medicine, the First Hospital of Lanzhou University, Lanzhou, Gansu 730000, PR China; School of Nursing, Lanzhou University, Lanzhou, Gansu 730000, PR China.
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Ha TS, Oh DK, Lee HJ, Chang Y, Jeong IS, Sim YS, Hong SK, Park S, Suh GY, Park SY. Liberation from mechanical ventilation in critically ill patients: Korean Society of Critical Care Medicine Clinical Practice Guidelines. Acute Crit Care 2024; 39:1-23. [PMID: 38476061 PMCID: PMC11002621 DOI: 10.4266/acc.2024.00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/14/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Successful liberation from mechanical ventilation is one of the most crucial processes in critical care because it is the first step by which a respiratory failure patient begins to transition out of the intensive care unit and return to their own life. Therefore, when devising appropriate strategies for removing mechanical ventilation, it is essential to consider not only the individual experiences of healthcare professionals, but also scientific and systematic approaches. Recently, numerous studies have investigated methods and tools for identifying when mechanically ventilated patients are ready to breathe on their own. The Korean Society of Critical Care Medicine therefore provides these recommendations to clinicians about liberation from the ventilator. METHODS Meta-analyses and comprehensive syntheses were used to thoroughly review, compile, and summarize the complete body of relevant evidence. All studies were meticulously assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method, and the outcomes were presented succinctly as evidence profiles. Those evidence syntheses were discussed by a multidisciplinary committee of experts in mechanical ventilation, who then developed and approved recommendations. RESULTS Recommendations for nine PICO (population, intervention, comparator, and outcome) questions about ventilator liberation are presented in this document. This guideline includes seven conditional recommendations, one expert consensus recommendation, and one conditional deferred recommendation. CONCLUSIONS We developed these clinical guidelines for mechanical ventilation liberation to provide meaningful recommendations. These guidelines reflect the best treatment for patients seeking liberation from mechanical ventilation.
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Affiliation(s)
- Tae Sun Ha
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Dong Kyu Oh
- Department of Pulmonology, Dongkang Medical Center, Ulsan, Korea
| | - Hak-Jae Lee
- Division of Acute Care Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youjin Chang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea
| | - In Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Gwangju, Korea
| | - Yun Su Sim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea
| | - Suk-Kyung Hong
- Division of Acute Care Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sunghoon Park
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea
- Department of Pulmonary, Allergy, and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Young Park
- Lung Research Institute of Hallym University College of Medicine, Chuncheon, Korea
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
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Karthika M, Al Enezi FA, Pillai LV, Arabi YM. Rate of Change of Rapid Shallow Breathing Index and Extubation Outcome in Mechanically Ventilated Patients. Crit Care Res Pract 2023; 2023:9141441. [PMID: 37795474 PMCID: PMC10547562 DOI: 10.1155/2023/9141441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/06/2023] [Accepted: 09/08/2023] [Indexed: 10/06/2023] Open
Abstract
Background Rapid shallow breathing index (RSBI) has been widely used as a predictor of extubation outcome in mechanically ventilated patients. We hypothesize that the rate of change of RSBI between the beginning and end of a 120-minute spontaneous breathing trial (SBT) could be a better predictor of extubation outcome than a single RSBI measured at the end of SBT in mechanically ventilated patients. Methodology. In this prospective observational study, we enrolled 193 patients who met the inclusion criteria, of whom 33 patients were unable to tolerate a 120-minute SBT and were excluded from the study. The study population consisted of 160 patients, categorized into three subgroups: patients with normal lung (no reported history of respiratory diseases), patients with airway disease, and patients with parenchymal disease who completed 120 minutes of SBT on low levels of pressure support ventilation. RSBI was obtained from the ventilator display at the 5th and the 120th minutes of SBT. The rate of change of RSBI (RSBI 5-120) was calculated as (RSBI 2-RSBI 1)/RSBI 1 × 100. Receiver-operating characteristic (ROC) curves were plotted for RSBI 5-120 and RSBI 120 in all patients and among the three subgroups (normal group, airway group, and parenchymal group) to compare the superiority of their best thresholds in predicting extubation failure. Results The RSBI 5-120 threshold for extubation failure in the entire patient group was 23% with an overall accuracy of 88% (AUC = 0.933, sensitivity = 91%, and specificity = 86%) and the threshold of RSBI 120 for extubation failure in the entire patient group was 70 breaths/min/L with an overall accuracy of 82% (AUC = 0.899, sensitivity = 85%, and specificity = 81%). In patients in the normal lung group, the threshold of RSBI 5-120 was 22%, with an overall accuracy of 89% (AUC = 0.892, sensitivity = 87.5%, and specificity = 90%), and the RSBI 120 threshold was 70 breaths/min/L, with an overall accuracy of 89% (AUC = 0.956, sensitivity = 88%, and specificity = 90%). The RSBI 5-120 threshold in patients with airway disease was 25% with an accuracy of 86% (AUC = 0.892, sensitivity = 85%, and specificity = 86%) and the threshold of RSBI 120 was 73 breaths/min/L with an accuracy of 83% (AUC = 0.874, sensitivity = 85%, and specificity = 82%). In patients in the parenchymal disease group, the threshold of RSBI 5-120 was 24%, with an accuracy of 90% (AUC = 0.966, sensitivity = 92%, and specificity = 89%) and RSBI 120 threshold was 71 breaths/min/L, which was 88% accurate (AUC = 0.893, sensitivity = 85%, and specificity = 89%). Conclusion The rate of change of RSBI between the 5th and 120th minutes was moderately more accurate than the single value of RSBI measured at the 120th minute in predicting extubation outcome.
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Affiliation(s)
- Manjush Karthika
- Faculty of Medical and Health Sciences, Liwa College, Abu Dhabi, UAE
- Faculty of Medical and Health Sciences, Symbiosis Centre for Research and Innovation, Symbiosis International University, Pune, India
| | - Farhan A. Al Enezi
- Intensive Care Department, King Abdulaziz Medical City, King Saud Bin Abdulaziz University of Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Lalitha V. Pillai
- Faculty of Medical and Health Sciences, Symbiosis Centre for Research and Innovation, Symbiosis International University, Pune, India
- Department of Critical Care Medicine, Aundh Institute of Medical Sciences, Pune, India
| | - Yaseen M. Arabi
- Intensive Care Department, King Abdulaziz Medical City, King Saud Bin Abdulaziz University of Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Khodabandeloo F, Froutan R, Yazdi AP, Shakeri MT, Mazlom SR, Moghaddam AB. The effect of threshold inspiratory muscle training on the duration of weaning in intensive care unit-admitted patients: A randomized clinical trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2023; 28:44. [PMID: 37405074 PMCID: PMC10315402 DOI: 10.4103/jrms.jrms_757_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/23/2022] [Accepted: 11/23/2022] [Indexed: 07/06/2023]
Abstract
Background The purpose of this study was to evaluate the effect of threshold inspiratory muscle training (IMT) on the duration of weaning in intensive care unit (ICU)-admitted patients. Materials and Methods This randomized clinical trial enrolled 79 ICU-admitted, mechanically ventilated patients in 2020-2021 in Imam Reza Hospital, Mashhad. Patients were randomly divided into intervention (n = 40) and control (n = 39) groups. The intervention group received threshold IMT and conventional chest physiotherapy, while the control group only received conventional chest physiotherapy once a day. Before and after the end of the intervention, the strength of inspiratory muscles and the duration of weaning were measured in both the groups. Results The duration of weaning was shorter in the intervention group (8.4 ± 1.1 days) versus the control group (11.2 ± 0.6 days) (P < 0.001). The rapid shallow breathing index decreased by 46.5% in the intervention group and by 27.3% in the control group after the intervention (both P < 0.001), and the between-group comparison showed a significantly higher reduction in the intervention group than control group (P < 0.001). The patients' compliance after the intervention compared to the 1st day increased to 16.2 ± 6.6 in the intervention group and 9.6 ± 6.8 in the control group (both P < 0.001), and the between-group comparison showed a significantly higher increase in the intervention group than control group. The maximum inspiratory pressure increased by 13.7 ± 6.1 in the intervention group and by 9.1 ± 6.0 in the control group (P < 0.001). Furthermore, the weaning success was 54% more probable in the intervention group than control group (P < 0.05). Conclusion The results of this study showed the positive effect of IMT with threshold IMT trainer on increased strength of respiratory muscles and reduced weaning duration.
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Affiliation(s)
- Farnoosh Khodabandeloo
- Medical Student, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Razieh Froutan
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Iran
| | - Arash Peivandi Yazdi
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Surgical Oncology Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Taghi Shakeri
- Department of Epidemiology and Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
- Sinus and Surgical Endoscopic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Reza Mazlom
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ahmad Bagheri Moghaddam
- Department of Anesthesiology and Critical Care, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Surgical Oncology Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Ng P, Tan HL, Ma YJ, Sultana R, Long V, Wong JJM, Lee JH. Tests and Indices Predicting Extubation Failure in Children: A Systematic Review and Meta-analysis. Pulm Ther 2023; 9:25-47. [PMID: 36459328 PMCID: PMC9931987 DOI: 10.1007/s41030-022-00204-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION There is lack of consensus on what constitutes best practice when assessing extubation readiness in children. This systematic review aims to synthesize data from existing literature on pre-extubation assessments and evaluate their diagnostic accuracies in predicting extubation failure (EF) in children. METHODS A systematic search in PubMed, EMBASE, Web of Science, CINAHL, and Cochrane was performed from inception of each database to 15 July 2021. Randomized controlled trials or observational studies that studied the association between pre-extubation assessments and extubation outcome in the pediatric intensive care unit population were included. Meta-analysis was performed for studies that report diagnostic tests results of a combination of parameters. RESULTS In total, 41 of 11,663 publications screened were included (total patients, n = 8111). Definition of EF across studies was heterogeneous. Fifty-five unique pre-extubation assessments were identified. Parameters most studied were: respiratory rate (RR) (13/41, n = 1945), partial pressure of arterial carbon dioxide (10/41, n = 1379), tidal volume (13/41, n = 1945), rapid shallow breathing index (RBSI) (9/41, n = 1400), and spontaneous breathing trials (SBT) (13/41, n = 5652). Meta-analysis shows that RSBI, compliance rate oxygenation pressure (CROP) index, and SBT had sensitivities ranging from 0.14 to 0.57. CROP index had the highest sensitivity [0.57, 95% confidence interval (CI) 0.4-0.73] and area under curve (AUC, 0.98). SBT had the highest specificity (0.93, 95% CI 0.92-0.94). CONCLUSIONS Pre-extubation assessments studied thus far remain poor predictors of EF. CROP index, having the highest AUC, should be further explored as a predictor of EF. Standardizing the EF definition will allow better comparison of pre-extubation assessments.
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Affiliation(s)
| | - Herng Lee Tan
- Children's Intensive Care Unit, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Yi-Jyun Ma
- Children's Intensive Care Unit, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | | | - Judith J-M Wong
- Duke-NUS Medical School, Singapore, Singapore.,Children's Intensive Care Unit, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Jan Hau Lee
- Duke-NUS Medical School, Singapore, Singapore. .,Children's Intensive Care Unit, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
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Knox KE, Hotz JC, Newth CJL, Khoo MCK, Khemani RG. A 30-Minute Spontaneous Breathing Trial Misses Many Children Who Go On to Fail a 120-Minute Spontaneous Breathing Trial. Chest 2023; 163:115-127. [PMID: 36037984 PMCID: PMC9993340 DOI: 10.1016/j.chest.2022.08.2212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/09/2022] [Accepted: 08/18/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The optimal length of spontaneous breathing trials (SBTs) in children is unknown. RESEARCH QUESTIONS What are the most common reasons for SBT failure in children, and when do they occur? Can clinical parameters at the 30-min mark of a 120-min SBT predict outcome? STUDY DESIGN AND METHODS We performed a secondary analysis of a clinical trial in pediatric ARDS, in which 2-h SBTs are conducted daily. SBT failure is based on objective criteria, including esophageal manometry for effort of breathing, categorized as passage, early failure (≤ 30 min), or late failure (30-120 min). Spirometry was used to calculate respiratory rate (RR), tidal volume (Vt), and rapid shallow breathing index (RSBI), in addition to pulse oximetry and capnography. Predictive models evaluated parameters at 30 min against SBT outcome, using receiver operating characteristic plots and area under the curve. RESULTS We included 100 children and 305 SBTs, with 42% of SBTs being successful, 32% failing within 30 min, and 25% failing between 30 and 120 min. Of the patients passing SBTs at 30 min, 40% went on to fail by 120 min. High respiratory effort (esophageal manometry) was present in > 80% of failed SBTs. At the 30-min mark, there were no clear thresholds for RR, Vt, RSBI, Fio2, oxygen saturation, or capnography that could reliably predict SBT outcome. Multivariable modeling identified RR (P < .001) and RSBI > 7 (P = .034) at 30 min, pre-SBT inspiratory pressure level (P = .009), and pre-SBT retractions (P = .042) as predictors for SBT failure, but this model performed poorly in an independent validation set with the receiver operating characteristic plot crossing the reference line (area under the curve, 0.67). INTERPRETATION A 30-min SBT may be too short in children recovering from pediatric ARDS because many go on to fail between 30 and 120 min. Reassuring values of Vt, RR, and gas exchange at 30 min do not reliably predict SBT passage at 2 h, likely because they do not capture the effort of breathing. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT03266016; URL: www. CLINICALTRIALS gov.
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Affiliation(s)
- Kelby E Knox
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA.
| | - Justin C Hotz
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Christopher J L Newth
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA; Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Michael C K Khoo
- Department of Biomedical Engineering, University of Southern California Viterbi School of Engineering, Los Angeles, CA
| | - Robinder G Khemani
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA; Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA
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Huang PH, Chen LY, Chung WC, Sheu CC, Hsiao TC, Tsai JR. Toward Evaluating Critical Factors of Extubation Outcome with XCSR-Generated Rules. Bioengineering (Basel) 2022; 9:bioengineering9110701. [PMID: 36421102 PMCID: PMC9687848 DOI: 10.3390/bioengineering9110701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
Predicting the correct timing for extubation is pivotal for critically ill patients with mechanical ventilation support. Evidence suggests that extubation failure occurs in approximately 15–20% of patients, despite their passing of the extubation evaluation, necessitating reintubation. For critically ill patients, reintubation invariably increases mortality risk and medical costs. The numerous parameters that have been proposed for extubation decision-making, which constitute the key predictors of successful extubation, remains unclear. In this study, an extended classifier system capable of processing real-value inputs was proposed to select features of successful extubation. In total, 40 features linked to clinical information and variables acquired during spontaneous breathing trial (SBT) were used as the environmental inputs. According to the number of “don’t care” rules in a population set, Probusage, the probability of the feature not being classified as above rules, can be calculated. A total of 228 subjects’ results showed that Probusage was higher than 90% for minute ventilation at the 1st, 30th, 60th, and 90th minutes; respiratory rate at the 90th minute; and body weight, indicating that the variance in respiratory parameters during an SBT are critical predictors of successful extubation. The present XCSR model is useful to evaluate critical factors of extubation outcomes. Additionally, the current findings suggest that SBT duration should exceed 90 min, and that clinicians should consider the variance in respiratory variables during an SBT before making extubation decisions.
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Affiliation(s)
- Po-Hsun Huang
- Institute of Computer Science and Engineering, College of Computer Science, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Lian-Yu Chen
- Institute of Computer Science and Engineering, College of Computer Science, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Wei-Chan Chung
- Division of Respiratory Therapy, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Tzu-Chien Hsiao
- Department of Computer Science, College of Computer Science, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
- Institute of Biomedical Engineering, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
- Correspondence: (T.-C.H.); (J.-R.T.)
| | - Jong-Rung Tsai
- Department of Internal Medicine, Kaohsiung Municipal Cijin Hospital, Kaohsiung 80544, Taiwan
- Division of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Correspondence: (T.-C.H.); (J.-R.T.)
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Chaudhuri S, Gupta N, Adhikari SD, Todur P, Maddani SS, Rao S. Utility of the One-time HACOR Score as a Predictor of Weaning Failure from Mechanical Ventilation: A Prospective Observational Study. Indian J Crit Care Med 2022; 26:900-905. [PMID: 36042760 PMCID: PMC9363817 DOI: 10.5005/jp-journals-10071-24280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim To determine the utility of the HACOR score in predicting weaning failure in resource-limited settings. Objectives The primary objective was to determine a cut-off value of the HACOR score, sensitivity, and specificity to predict failed weaning. The secondary objective was to determine which out of five components of the score was significantly different between the successful weaning and the failed weaning groups. Introduction Most weaning indices are either inaccurate or are dependent on complex ventilatory parameters, which are difficult to measure in resource-limited settings. This study aimed to determine the utility of the HACOR score consisting of heart rate, acidosis, consciousness level, oxygenation, and respiratory rate as a predictor of weaning in the intensive care unit. Materials and methods It was a prospective observational study on 120 patients between 18 and 90 years. The HACOR score was evaluated at 30 minutes of spontaneous breathing trial (SBT). The total duration of SBT was 120 minutes. Results Out of 120 patients, 83 (69.2%) had successful weaning, whereas 37 (30.8%) had weaning failure. The median and interquartile range (IQR) of the HACOR score in the successful weaning group was 2 (0–3) and 6 (5–8) in the failed weaning group (p-value <0.001). There was a significant difference in each of the five components of the HACOR score between the successful and failed weaning groups (p <0.05). HACOR score ≥5 predicted failed weaning, sensitivity 83.8%, specificity 96.4%, area under the curve (AUC) 0.950, and 95% confidence interval (CI) [0.907–0.993], p <0.001. Multivariable logistic regression analysis showed that HACOR score ≥5 is an independent predictor of weaning failure [p <0.001, 95% CI (1.9–4.2), adjusted odds ratio 2.82]. Conclusion A HACOR score ≥5 is an excellent predictor of weaning failure. This score may be useful as a weaning strategy in the intensive care unit. How to cite this article Chaudhuri S, Gupta N, Adhikari SD, Todur P, Maddani SS, Rao S. Utility of the One-time HACOR Score as a Predictor of Weaning Failure from Mechanical Ventilation: A Prospective Observational Study. Indian J Crit Care Med 2022;26(8):900–905. Ethical approval Prior to the commencement of the study, Institutional Ethics Committee permission was obtained (IEC: 197/2021) and Clinical Trial Registry of India (CTRI) registration was done before recruitment (CTRI/2021/07/035139). We obtained written informed consent from the legally authorized representative prior to recruiting patients for the study.
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Affiliation(s)
- Souvik Chaudhuri
- Department of Critical Care Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Nitin Gupta
- Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shreya Das Adhikari
- Department of Anaesthesia, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Pratibha Todur
- Department of Respiratory Therapy, Manipal College of Health Professionals, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sagar Shanmukhappa Maddani
- Department of Critical Care Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shwethapriya Rao
- Department of Critical Care Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Shwethapriya Rao, Department of Critical Care Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India, Phone: +91 9964668404, e-mail:
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Tanaka A, Kabata D, Hirao O, Kosaka J, Furushima N, Maki Y, Uchiyama A, Egi M, Shintani A, Morimatsu H, Mizobuchi S, Kotake Y, Fujino Y. Prediction Model of Extubation Outcomes in Critically Ill Patients: A Multicenter Prospective Cohort Study. J Clin Med 2022; 11:jcm11092520. [PMID: 35566646 PMCID: PMC9102390 DOI: 10.3390/jcm11092520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 02/05/2023] Open
Abstract
Liberation from mechanical ventilation is of great importance owing to related complications from extended ventilation time. In this prospective multicenter study, we aimed to construct a versatile model for predicting extubation outcomes in critical care settings using obtainable physiological predictors. The study included patients who had been extubated after a successful 30 min spontaneous breathing trial (SBT). A multivariable logistic regression model was constructed to predict extubation outcomes (successful extubation without reintubation and uneventful extubation without reintubation or noninvasive respiratory support) using eight parameters: age, heart failure, respiratory disease, rapid shallow breathing index (RSBI), PaO2/FIO2, Glasgow Coma Scale score, fluid balance, and endotracheal suctioning episodes. Of 499 patients, 453 (90.8%) and 328 (65.7%) achieved successful and uneventful extubation, respectively. The areas under the curve for successful and uneventful extubation in the novel prediction model were 0.69 (95% confidence interval (CI), 0.62−0.77) and 0.70 (95% CI, 0.65−0.74), respectively, which were significantly higher than those in the conventional model solely using RSBI (0.58 (95% CI, 0.50−0.66) and 0.54 (95% CI, 0.49−0.60), p = 0.004 and <0.001, respectively). The model was validated using a bootstrap method, and an online application was developed for automatic calculation. Our model, which is based on a combination of generally obtainable parameters, established an accessible method for predicting extubation outcomes after a successful SBT.
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Affiliation(s)
- Aiko Tanaka
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita 565-0871, Japan; (A.U.); (Y.F.)
- Correspondence: ; Tel.: +81-6-6879-5820; Fax: +81-6-6879-5823
| | - Daijiro Kabata
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (D.K.); (A.S.)
| | - Osamu Hirao
- Department of Anesthesiology, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka 558-8558, Japan;
| | - Junko Kosaka
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; (J.K.); (H.M.)
| | - Nana Furushima
- Department of Anesthesiology and Intensive Care Medicine, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan; (N.F.); (M.E.); (S.M.)
| | - Yuichi Maki
- Department of Anesthesiology, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo 153-8515, Japan; (Y.M.); (Y.K.)
| | - Akinori Uchiyama
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita 565-0871, Japan; (A.U.); (Y.F.)
| | - Moritoki Egi
- Department of Anesthesiology and Intensive Care Medicine, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan; (N.F.); (M.E.); (S.M.)
| | - Ayumi Shintani
- Department of Medical Statistics, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan; (D.K.); (A.S.)
| | - Hiroshi Morimatsu
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; (J.K.); (H.M.)
| | - Satoshi Mizobuchi
- Department of Anesthesiology and Intensive Care Medicine, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan; (N.F.); (M.E.); (S.M.)
| | - Yoshifumi Kotake
- Department of Anesthesiology, Toho University Ohashi Medical Center, 2-22-36 Ohashi, Meguro-ku, Tokyo 153-8515, Japan; (Y.M.); (Y.K.)
| | - Yuji Fujino
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita 565-0871, Japan; (A.U.); (Y.F.)
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10
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Chen WT, Huang HL, Ko PS, Su W, Kao CC, Su SL. A Simple Algorithm Using Ventilator Parameters to Predict Successfully Rapid Weaning Program in Cardiac Intensive Care Unit Patients. J Pers Med 2022; 12:501. [PMID: 35330500 PMCID: PMC8950402 DOI: 10.3390/jpm12030501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/25/2022] [Accepted: 03/19/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Ventilator weaning is one of the most significant challenges in the intensive care unit (ICU). Approximately 30% of patients fail to wean, resulting in prolonged use of ventilators and increased mortality. There are numerous high-performance prediction models available today, but they require a large number of parameters to predict and are thus impractical in clinical practice. OBJECTIVES This study aims to create an artificial intelligence (AI) model for predicting weaning time and to identify the most simplified key predictors that will allow the model to achieve adequate accuracy with as few parameters as possible. METHODS This is a retrospective study of to-be-weaned patients (n = 1439) hospitalized in the cardiac ICU of Cheng Hsin General Hospital's Department of Cardiac Surgery from November 2018 to August 2020. The patients were divided into two groups based on whether they could be weaned within 24 h (i.e., "patients weaned within 24 h" (n = 1042) and "patients not weaned within 24 h" (n = 397)). Twenty-eight variables were collected including demographic characteristics, arterial blood gas readings, and ventilation set parameters. We created a prediction model using logistic regression and compared it to other machine learning techniques such as decision tree, random forest, support vector machine (SVM), extreme gradient boosting, and artificial neural network. Forward, backward, and stepwise selection methods were used to identify significant variables, and the receiver operating characteristic curve was used to assess the accuracy of each AI model. RESULTS The SVM [receiver operating characteristic curve (ROC-AUC) = 88%], logistic regression (ROC-AUC = 86%), and XGBoost (ROC-AUC = 85%) models outperformed the other five machine learning models in predicting weaning time. The accuracies in predicting patient weaning within 24 h using seven variables (i.e., expiratory minute ventilation, expiratory tidal volume, ventilation rate set, heart rate, peak pressure, pH, and age) were close to those using 28 variables. CONCLUSIONS The model developed in this research successfully predicted the weaning success of ICU patients using a few and easily accessible parameters such as age. Therefore, it can be used in clinical practice to identify difficult-to-wean patients to improve their treatment.
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Affiliation(s)
- Wei-Teing Chen
- Division of Thoracic Medicine, Department of Medicine, Cheng Hsin General Hospital, Tri-Service General Hospital, National Defense Medical Center, Taipei 112401, Taiwan;
| | - Hai-Lun Huang
- School of Public Health, National Defense Medical Center, Taipei 114201, Taiwan; (H.-L.H.); (P.-S.K.); (W.S.)
| | - Pi-Shao Ko
- School of Public Health, National Defense Medical Center, Taipei 114201, Taiwan; (H.-L.H.); (P.-S.K.); (W.S.)
| | - Wen Su
- School of Public Health, National Defense Medical Center, Taipei 114201, Taiwan; (H.-L.H.); (P.-S.K.); (W.S.)
- Institute of Aerospace and Undersea Medic, National Defense Medical Center, Taipei 114201, Taiwan
| | - Chung-Cheng Kao
- Tri-Service General Hospital Songshan Branch, National Defense Medical Center, Taipei 105309, Taiwan;
| | - Sui-Lung Su
- School of Public Health, National Defense Medical Center, Taipei 114201, Taiwan; (H.-L.H.); (P.-S.K.); (W.S.)
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11
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Trivedi V, Chaudhuri D, Jinah R, Piticaru J, Agarwal A, Liu K, McArthur E, Sklar MC, Friedrich JO, Rochwerg B, Burns KEA. The Usefulness of the Rapid Shallow Breathing Index in Predicting Successful Extubation: A Systematic Review and Meta-analysis. Chest 2022; 161:97-111. [PMID: 34181953 DOI: 10.1016/j.chest.2021.06.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/21/2021] [Accepted: 06/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Clinicians use several measures to ascertain whether individual patients will tolerate liberation from mechanical ventilation, including the rapid shallow breathing index (RSBI). RESEARCH QUESTION Given varied use of different thresholds, patient populations, and measurement characteristics, how well does RSBI predict successful extubation? STUDY DESIGN AND METHODS We searched six databases from inception through September 2019 and selected studies reporting the accuracy of RSBI in the prediction of successful extubation. We extracted study data and assessed quality independently and in duplicate. RESULTS We included 48 studies involving RSBI measurements of 10,946 patients. Pooled sensitivity for RSBI of < 105 in predicting extubation success was moderate (0.83 [95% CI, 0.78-0.87], moderate certainty), whereas specificity was poor (0.58 [95% CI, 0.49-0.66], moderate certainty) with diagnostic ORs (DORs) of 5.91 (95% CI, 4.09-8.52). RSBI thresholds of < 80 or 80 to 105 yielded similar sensitivity, specificity, and DOR. These findings were consistent across multiple subgroup analyses reflecting different patient characteristics and operational differences in RSBI measurement. INTERPRETATION As a stand-alone test, the RSBI has moderate sensitivity and poor specificity for predicting extubation success. Future research should evaluate its role as a permissive criterion to undergo a spontaneous breathing trial (SBT) for patients who are at intermediate pretest probability of passing an SBT. TRIAL REGISTRY PROSPERO; No.: CRD42020149196; URL: www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Vatsal Trivedi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Dipayan Chaudhuri
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Rehman Jinah
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Joshua Piticaru
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Arnav Agarwal
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kuan Liu
- Dalla Lana School of Public Health, St. Michael's Hospital, Toronto, ON, Canada
| | | | - Michael C Sklar
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Jan O Friedrich
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
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12
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Torrini F, Gendreau S, Morel J, Carteaux G, Thille AW, Antonelli M, Mekontso Dessap A. Prediction of extubation outcome in critically ill patients: a systematic review and meta-analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:391. [PMID: 34782003 PMCID: PMC8591441 DOI: 10.1186/s13054-021-03802-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/24/2021] [Indexed: 12/29/2022]
Abstract
Background Extubation failure is an important issue in ventilated patients and its risk factors remain a matter of research. We conducted a systematic review and meta-analysis to explore factors associated with extubation failure in ventilated patients who passed a spontaneous breathing trial and underwent planned extubation. This systematic review was registered in PROPERO with the Registration ID CRD42019137003. Methods We searched the PubMed, Web of Science and Cochrane Controlled Register of Trials for studies published from January 1998 to December 2018. We included observational studies involving risk factors associated with extubation failure in adult intensive care unit patients who underwent invasive mechanical ventilation. Two authors independently extracted data and assessed the validity of included studies. Results Sixty-seven studies (involving 26,847 participants) met the inclusion criteria and were included in our meta-analysis. We analyzed 49 variables and, among them, we identified 26 factors significantly associated with extubation failure. Risk factors were distributed into three domains (comorbidities, acute disease severity and characteristics at time of extubation) involving mainly three functions (circulatory, respiratory and neurological). Among these, the physiological respiratory characteristics at time of extubation were the most represented. The individual topic of secretion management was the one with the largest number of variables. By Bayesian multivariable meta-analysis, twelve factors were significantly associated with extubation failure: age, history of cardiac disease, history of respiratory disease, Simplified Acute Physiologic Score II score, pneumonia, duration of mechanical ventilation, heart rate, Rapid Shallow Breathing Index, negative inspiratory force, lower PaO2/FiO2 ratio, lower hemoglobin level and lower Glasgow Coma Scale before extubation, with the latest factor having the strongest association with extubation outcome. Conclusions Numerous factors are associated with extubation failure in critically ill patients who have passed a spontaneous breathing trial. Robust multiparametric clinical scores and/or artificial intelligence algorithms should be tested based on the selected independent variables in order to improve the prediction of extubation outcome in the clinical scenario. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03802-3.
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Affiliation(s)
- Flavia Torrini
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 rue Gustave Eiffel, 94010, Créteil Cedex, France.,CARMAS, Univ Paris Est Créteil, 94010, Créteil, France
| | - Ségolène Gendreau
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 rue Gustave Eiffel, 94010, Créteil Cedex, France.,CARMAS, Univ Paris Est Créteil, 94010, Créteil, France
| | - Johanna Morel
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 rue Gustave Eiffel, 94010, Créteil Cedex, France.,CARMAS, Univ Paris Est Créteil, 94010, Créteil, France
| | - Guillaume Carteaux
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 rue Gustave Eiffel, 94010, Créteil Cedex, France.,CARMAS, Univ Paris Est Créteil, 94010, Créteil, France.,INSERM, IMRB, Univ Paris Est Créteil, 94010, Créteil, France
| | - Arnaud W Thille
- Centre d'Investigation Clinique 1402 ALIVE, Université de Poitiers, Poitiers, France.,Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | | | - Armand Mekontso Dessap
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, AP-HP, 1 rue Gustave Eiffel, 94010, Créteil Cedex, France. .,CARMAS, Univ Paris Est Créteil, 94010, Créteil, France. .,INSERM, IMRB, Univ Paris Est Créteil, 94010, Créteil, France.
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13
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Huang PH, Chung WC, Sheu CC, Tsai JR, Hsiao TC. Is the asynchronous phase of thoracoabdominal movement a novel feature of successful extubation? A preliminary result. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:752-756. [PMID: 34891400 DOI: 10.1109/embc46164.2021.9629920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Mechanical ventilation is necessary to maintain patients' life in intensive care units. However, too early or too late extubation may injure the muscles or lead to respiratory failure. Therefore, the spontaneous breathing trial (SBT) is applied for testing whether the patients can spontaneously breathe or not. However, previous evidence still reported 15%~20% of the rate of extubation fail. The monitor only considers the ventilation variables during SBT. Therefore, this study measures the asynchronization between thoracic and abdomen wall movement (TWM and AWM) by using instantaneous phase difference method (IPD) during SBT for 120 minutes. The respiratory inductive plethysmography were used for TWM and AWM measurement. The preliminary result recruited 31 signals for further analysis. The result showed that in successful extubation group can be classified into two groups, IPD increase group, and IPD decrease group; but in extubation fail group, the IPD value only increase. Therefore, the IPD decrease group can almost perfectly be discriminated with extubation fail group, especially after 70 minutes (Area under curve of operating characteristic curve was 1). These results showed IPD is an important key factor to find whether the patient is suitable for extubation or not. These finding suggest that the asynchronization between TWM and AWM should be considered as a predictor of extubation outcome. In future work, we plan to recruit 150 subjects to validate the result of this preliminary result. In addition, advanced machine learning method is considered to apply for building effective models to discriminate the IPD increase group and extubation fail group.Clinical Relevance- The finding of this study is that the patients whose average IPD of 95 to 100 minutes was smaller than average IPD of first 5 minutes of SBT could be 100% successful extubation. In addition, ability of discrimination of average IPD after 70 minutes presents AUC 1.
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14
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Fossat G, Daillet B, Desmalles E, Boulain T. Does diaphragm ultrasound improve the rapid shallow breathing index accuracy for predicting the success of weaning from mechanical ventilation? Aust Crit Care 2021; 35:233-240. [PMID: 34340902 DOI: 10.1016/j.aucc.2021.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 05/27/2021] [Accepted: 05/29/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This prospective study investigated whether taking into account diaphragmatic excursion (DE) measured by ultrasonography would improve the performance of the rapid shallow breathing index (RSBI) to predict extubation success or failure. OBJECTIVES The aim of the study was to compare the new composite index named the rapid shallow diaphragmatic index (RSDI), and the RSBI measured during a spontaneous breathing trial regarding their ability to predict the need for re-intubation at 72 h. METHODS One hundred mechanically ventilated patients underwent daily 30-min spontaneous breathing trials (SBTs) under pressure support ventilation of 6 cm H2O and end-expiratory pressure of 0 cm H2O until the SBT was considered successful and followed by extubation. The performances of RSBI (respiratory rate/tidal volume) and of the ratio RSBI/DE measured at 5 and 25 min of the successful SBT were compared in terms of area under the receiver operating characteristics curve (AUC), for predicting extubation success at 72 h. As secondary analysis, extubation and weaning success at 7 d were also considered. As exploratory analyses, predictive indices incorporating both clinical characteristics, the DE, and ultrasound diaphragm thickening fraction (DTF) were investigated. RESULTS RSBI and RSBI/DE showed AUCs with 95% confidence intervals consistently extending below 0.50, either at the 5th (0.55 [0.36-0.74] and 0.55 [0.34-0.75], respectively) or at the 25th minute of SBT (0.49 [0.27-0.71] and 0.50 [0.29-0.68], respectively) for predicting weaning success at 72 h or at 7 d (5th min: 0.53 [0.37-0.70] and 0.54 [0.37-0.70], respectively; 25th min: 0.54 [0.37-0.71] and 0.55 [0.39-0.71], respectively). An exploratory index incorporating the accessory respiratory muscle activity, DE, DTF, and respiratory rate at 5th min of SBT showed AUCs for predicting extubation success at 7 d in the 78 patients with DTF measurement (0.77 [0.64-0.90]) that were significantly higher than that of the RSBI (P = 0.017) and RSBI/DE (P < 0.001) in the same respective populations. CONCLUSIONS The RSBI and the ratio RSBI/DE failed to predict weaning success when measured during an SBT performed under minimal pressure support. Predictive indices incorporating ultrasound DE and DTF may merit further investigation.
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Affiliation(s)
- Guillaume Fossat
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France.
| | - Blanche Daillet
- Ecole Universitaire de Kinésithérapie Centre Val de Loire, Orléans, France.
| | - Emmanuelle Desmalles
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France.
| | - Thierry Boulain
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France.
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15
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An Evaluation of Risk Factors for Extubation Failure in Surgical Patients in Intensive Care. Dimens Crit Care Nurs 2019; 38:256-263. [PMID: 31369445 DOI: 10.1097/dcc.0000000000000380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Reintubations following extubation from mechanical ventilation are costly, resulting in increased morbidity and mortality. The preparation for and timing of extubation from mechanical ventilation can reduce unplanned reintubations. Few studies have investigated reintubation in the surgical intensive care unit (SICU) population. OBJECTIVE To identify risk factors that predict extubation failure in nontrauma surgical postoperative intensive care patients. METHODS Retrospective analysis utilizing American College of Surgeons National Surgical Quality Improvement Program data and institutional clinical variables from July 1, 2013, to December 31, 2015, in a sample (N = 93) of surgical patients admitted postoperatively to a SICU with an endotracheal tube in place, requiring invasive mechanical ventilation. Logistic regression analysis was used to model extubation failure as a function of clinical variables in the 24 hours preceding extubation. RESULTS Of 93 patients, 70 were successfully extubated, and 23 experienced failure. Increasing respiratory rate in the 24 hours preceding extubation significantly predicted failure (odds ratio, 1.086; 95% confidence interval, 1.006-1.172; P = .034). DISCUSSION Elevated respiratory rates during the 24 hours preceding extubation are an underappreciated risk factor for extubation failure. This has direct implications for nurses who are assessing intensive care unit patients' readiness for extubation. Opportunity exists for nurses to better integrate respiratory rate data into extubation planning to improve unplanned reintubation rates in SICU patients.
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16
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Rittayamai N, Hemvimon S, Chierakul N. The evolution of diaphragm activity and function determined by ultrasound during spontaneous breathing trials. J Crit Care 2019; 51:133-138. [DOI: 10.1016/j.jcrc.2019.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 11/28/2022]
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17
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Mowafy SM, Abdelgalel EF. Diaphragmatic rapid shallow breathing index for predicting weaning outcome from mechanical ventilation: Comparison with traditional rapid shallow breathing index. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2018.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Sherif M.S. Mowafy
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Essam F. Abdelgalel
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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18
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Baptistella AR, Sarmento FJ, da Silva KR, Baptistella SF, Taglietti M, Zuquello RÁ, Nunes Filho JR. Predictive factors of weaning from mechanical ventilation and extubation outcome: A systematic review. J Crit Care 2018; 48:56-62. [PMID: 30172034 DOI: 10.1016/j.jcrc.2018.08.023] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/06/2018] [Accepted: 08/18/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To identify, describe and discuss the parameters used to predict weaning from mechanical ventilation and extubation outcomes. METHODS Systematic review of scientific articles using four electronic databases: PubMed, Embase, PEDro and Cochrane Library. Search terms included "weaning", "extubation", "withdrawal" and "discontinuation", combined with "mechanical ventilation" and "predictive factors", "predictive parameters" and "predictors for success". In this study, we included original articles that presented predictive factors for weaning or extubation outcomes in adult patients and not restricted to a single disease. Articles not written in English were excluded. RESULTS A total of 43 articles were included, with a total of 7929 patients and 56 different parameters related to weaning and extubation outcomes. Rapid Shallow Breathing Index (RSBI) was the most common predictor, discussed in 15 studies (2159 patients), followed by Age and Maximum Inspiratory Pressure in seven studies. The other 53 parameters were found in less than six studies. CONCLUSION There are several parameters used to predict weaning and extubation outcomes. RSBI was the most frequently studied and seems to be an important measurement tool in deciding whether to wean/extubate a patient. Furthermore, the results demonstrated that weaning and extubation should be guided by several parameters, and not only to respiratory ones.
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Affiliation(s)
- Antuani Rafael Baptistella
- Universidade do Oeste de Santa Catarina (UNOESC), Joaçaba, SC, Brazil; Programa de Pós-Graduação em Biociências e Saúde/Universidade do Oeste de Santa Catarina, Brazil; Hospital Universitário Santa Terezinha, Joaçaba, SC, Brazil.
| | | | | | - Shaline Ferla Baptistella
- Universidade do Oeste de Santa Catarina (UNOESC), Joaçaba, SC, Brazil; Programa de Pós-Graduação em Biociências e Saúde/Universidade do Oeste de Santa Catarina, Brazil; Hospital Universitário Santa Terezinha, Joaçaba, SC, Brazil
| | | | | | - João Rogério Nunes Filho
- Universidade do Oeste de Santa Catarina (UNOESC), Joaçaba, SC, Brazil; Hospital Universitário Santa Terezinha, Joaçaba, SC, Brazil
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19
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Lombardi FS, Cotoia A, Petta R, Schultz M, Cinnella G, Horn J. Prediction of extubation failure in Intensive Care Unit: systematic review of parameters investigated. Minerva Anestesiol 2018; 85:298-307. [PMID: 29991220 DOI: 10.23736/s0375-9393.18.12627-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Extubation failure (EF) refers to the inability to maintain spontaneous breathing after removal of endotracheal tube. The aim of this review is to identify the best parameter to predict EF in adult intensive care patients. EVIDENCE ACQUISITION We searched for publications in PubMed (2000-2016). Studies of patients intubated and mechanically ventilated for more than 24 hours were included and divided in groups basing on the extubation method. 2x2 tables were performed to evaluate the sensitivity, specificity and the predictive values only for those parameters investigated in more than three studies. Studies were divided in groups, basing on time required to define EF (<24 hours, <72 or >72 hours), and EF percentage was calculated for each group. EVIDENCE SYNTHESIS On 443 potentially studies, 26 were included. Rapid Shallow Breathing Index (RSBI) and cough strength parameters were found in more than three studies. RSBI or cough strength parameter showed a sensitivity of 20-88.8% or 55.5-85.2%, a specificity of 68.5-94.8% or 24-49%, a positive predictive value (PPV) of 39.5-66.6% or 24-49% and a negative predictive value of 98-82% or 89.5-96.4%, respectively. EF rate was 12.5%, 15.3% and 22% in patients evaluated within 24 hours, 72 hours and over 72 hours, respectively. CONCLUSIONS This review shows that all parameters used to predict EF have a low PPV. Therefore, the limitation of use of such predictive tests may prolong unnecessarily the intubation and increase the unfavorable outcome. A prospective study involving all variables could be useful to predict the EF in ICU.
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Affiliation(s)
- Filomena S Lombardi
- Department of Anesthesia, Intensive Care and Pain Therapy, University Hospital of Foggia, University of Foggia, Foggia, Italy
| | - Antonella Cotoia
- Department of Anesthesia, Intensive Care and Pain Therapy, University Hospital of Foggia, University of Foggia, Foggia, Italy -
| | - Rocco Petta
- Department of Anesthesia, Intensive Care and Pain Therapy, University Hospital of Foggia, University of Foggia, Foggia, Italy
| | - Marcus Schultz
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.,Academic Medical Center, Amsterdam, The Netherlands
| | - Gilda Cinnella
- Department of Anesthesia, Intensive Care and Pain Therapy, University Hospital of Foggia, University of Foggia, Foggia, Italy
| | - Janneke Horn
- Neurologist-Intensivist Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands
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Zhou P, Zhang Z, Hong Y, Cai H, Zhao H, Xu P, Zhao Y, Lin S, Qin X, Guo J, Pan Y, Dai J. The predictive value of serial changes in diaphragm function during the spontaneous breathing trial for weaning outcome: a study protocol. BMJ Open 2017; 7:e015043. [PMID: 28645964 PMCID: PMC5623446 DOI: 10.1136/bmjopen-2016-015043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION There is a variety of tools being used in clinical practice for the prediction of weaning success from mechanical ventilation. However, their diagnostic performances are less than satisfactory. The purpose of this study is to investigate the value of serial changes in diaphragm function measured by ultrasound during the spontaneous breathing trial (SBT) as a weaning predictor. METHODS AND ANALYSIS This is a prospective observational study conducted in a 10-bed medical emergency intensive care unit (EICU) in a university-affiliated hospital. The study will be performed from November 2016 to December 2017. All patients in the EICU who are expected to have mechanical ventilation for more than 48 hours through endotracheal tube are potentially eligible for this study. Patients will be included if they fulfil the criteria for SBT. All enrolled patients will be ventilated with an Evita-4 by using volume assist control mode prior to SBT. Positive end-expiratory pressure (PEEP) will be set to 5 cmH2O and fractional inspired oxygen (FiO2) will be set to a value below 0.5 that guarantees oxygen saturation by pulse oximetry (SpO2) greater than 90%. Enrolled patients will undergo SBT for 2 hours in semirecumbent position. During the SBT, the patients will breathe through the ventilator circuit by using flow triggering (2 L/min) with automatic tube compensation of 100% and 5 cmH2O PEEP. The FiO2 will be set to the same value as used before SBT. If the patients fail to tolerate the SBT, the trial will be discontinued immediately and the ventilation mode will be switched to that used before the trial. Patients who pass the 2-hour SBT will be extubated. Right diaphragm excursion and bilateral diaphragm thickening fraction will be measured by ultrasonography during spontaneous breathing. Images will be obtained immediately prior to the SBT, and at 5, 30, 60, 90 and 120 min after the initiation of SBT. Rapid shallow breathing index will be simultaneously calculated at the bedside by a respiratory nurse. ETHICS AND DISSEMINATION The study protocol is approved by the ethics committee of Sir Run Run Shaw Hospital, an affiliate of Zhejiang University, Medical College. The results will be published in a peer-reviewed journal and shared with the worldwide medical community. TRIAL REGISTRATION NUMBER ISRCTN42917473; Pre-results.
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Affiliation(s)
- Pengmin Zhou
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhongheng Zhang
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yucai Hong
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huabo Cai
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Zhao
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peifeng Xu
- Department of Respiratory Therapy Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiming Zhao
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shengping Lin
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xuchang Qin
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - JiaWei Guo
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yun Pan
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Junru Dai
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Abstract
Predicting successful liberation of patients from mechanical ventilation has been a focus of interest to clinicians practicing in intensive care. Various weaning indices have been investigated to identify an optimal weaning window. Among them, the rapid shallow breathing index (RSBI) has gained wide use due to its simple technique and avoidance of calculation of complex pulmonary mechanics. Since its first description, several modifications have been suggested, such as the serial measurements and the rate of change of RSBI, to further improve its predictive value. The objective of this paper is to review the utility of RSBI in predicting weaning success. In addition, the use of RSBI in specific patient populations and the reported modifications of RSBI technique that attempt to improve the utility of RSBI are also reviewed.
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Affiliation(s)
- Manjush Karthika
- Faculty of Health and Biomedical Sciences, Symbiosis Institute of Research and Innovation, Symbiosis International University, Pune, India
| | - Farhan A Al Enezi
- Intensive Care Department, King Saud Bin Abdulaziz University of Health Sciences and King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Lalitha V Pillai
- Faculty of Health and Biomedical Sciences, Symbiosis Institute of Research and Innovation, Symbiosis International University, Pune, India; Department of Critical Care Medicine, Aundh Institute of Medical Sciences, Pune, India
| | - Yaseen M Arabi
- Intensive Care Department, King Saud Bin Abdulaziz University of Health Sciences and King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
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Predictive value of rapid shallow breathing index in relation to the weaning outcome in ICU patients. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2016.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Liu Y, Mu YU, Li GQ, Yu X, Li PJ, Shen ZQ, Wang HX, Wei LQ. Extubation outcome after a successful spontaneous breathing trial: A multicenter validation of a 3-factor prediction model. Exp Ther Med 2015; 10:1591-1601. [PMID: 26622532 PMCID: PMC4578010 DOI: 10.3892/etm.2015.2678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 08/03/2015] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to validate, and if necessary update, a predictive model previously developed using a classification and regression tree (CART) algorithm for predicting successful extubation (ES) using a new cohort. This prospective cohort study enrolled adults admitted to 10 intensive care units, who had successfully passed a spontaneous breathing trial (SBT) and were considered ready for extubation. After extubation, the patients were followed up for 48 h. The primary outcome measure was ES, defined as the ability to maintain spontaneous unassisted breathing for >48 h after extubation. The 3-factor CART model was applied to patients in this cohort. The predicted probability of ES for each patient in this validation cohort was calculated based on the original CART model using the Laplace correction method. The performance was assessed by discrimination and calibration. A decision curve analysis was used assess the clinical net benefit (NB). Extubation failure (EF) occurred in 90/530 patients (17%). Among the 90 patients, 72 (13.6%) were reintubated, while 18 patients remained on rescue noninvasive ventilation within 48 h after extubation. The original CART model showed high discrimination but only moderate calibration with predicted probabilities that were systematically lower than expected. The original CART model was updated, and the updated model preserved excellent discrimination (area under the receiver operating characteristic curve, 0.91; 95% confidence interval, 0.87 to 0.93), but exhibited near-perfect calibration (calibration slope, 1; intercept, 0). Between threshold probabilities of 50 and 80%, the NB of using this updated model is significantly improved compared with the current strategy. The updated CART model may be used to estimate the predicted probability of ES after a successful SBT for individual patients. Applying this model appears to produce a substantial clinical consequence with regard to potential reduction in unexpected EFs.
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Affiliation(s)
- Yang Liu
- Medical Intensive Care Unit, Pingjin Hospital, Logistics College of The Chinese People's Armed Police Forces, Tianjin 300162, P.R. China
| | - Y U Mu
- Coronary Care Unit, Tianjin Chest Hospital, Teaching Hospital of Tianjin Medical University, Tianjin 300051, P.R. China
| | - Guo-Qiang Li
- Medical Intensive Care Unit, Pingjin Hospital, Logistics College of The Chinese People's Armed Police Forces, Tianjin 300162, P.R. China
| | - Xin Yu
- Surgical Intensive Care Unit, Pingjin Hospital, Logistics College of The Chinese People's Armed Police Forces, Tianjin 300162, P.R. China
| | - Pei-Jun Li
- General Intensive Care Unit, Tianjin Chest Hospital, Teaching Hospital of Tianjin Medical University, Tianjin 300051, P.R. China
| | - Zhi-Qi Shen
- Coronary Care Unit, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, P.R. China
| | - Hao-Xun Wang
- General Intensive Care Unit, Xizang Corps Hospital, Teaching Hospital of Tibet University, Lhasa, Tibet 850000, P.R. China
| | - Lu-Qing Wei
- Medical Intensive Care Unit, Pingjin Hospital, Logistics College of The Chinese People's Armed Police Forces, Tianjin 300162, P.R. China
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Silva MGBE, Borges DL, Costa MDAG, Baldez TEP, da Silva LN, Oliveira RL, Ferreira TDFR, Albuquerque RAM. Application of Mechanical Ventilation Weaning Predictors After Elective Cardiac Surgery. Braz J Cardiovasc Surg 2015; 30:605-9. [PMID: 26934398 PMCID: PMC4762550 DOI: 10.5935/1678-9741.20150076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 11/03/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To test several weaning predictors as determinants of successful extubation after elective cardiac surgery. METHODS The study was conducted at a tertiary hospital with 100 adult patients undergoing elective cardiac surgery from September to December 2014. We recorded demographic, clinical and surgical data, plus the following predictive indexes: static compliance (Cstat), tidal volume (Vt), respiratory rate (f), f/ Vt ratio, arterial partial oxygen pressure to fraction of inspired oxygen ratio (PaO2/FiO2), and the integrative weaning index (IWI). Extubation was considered successful when there was no need for reintubation within 48 hours. Sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were used to evaluate each index. RESULTS The majority of the patients were male (60%), with mean age of 55.4±14.9 years and low risk of death (62%), according to InsCor. All of the patients were successfully extubated. Tobin Index presented the highest SE (0.99) and LR+ (0.99), followed by IWI (SE=0.98; LR+ =0.98). Other scores, such as SP, NPV and LR-were nullified due to lack of extubation failure. CONCLUSION All of the weaning predictors tested in this sample of patients submitted to elective cardiac surgery showed high sensitivity, highlighting f/Vt and IWI.
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Affiliation(s)
| | - Daniel Lago Borges
- University Hospital of Universidade Federal do
Maranhão (HUUFMA), São Luís, MA, Brazil
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dos Reis HFC, Almeida MLO, da Silva MF, Moreira JO, Rocha MDS. Association between the rapid shallow breathing index and extubation success in patients with traumatic brain injury. Rev Bras Ter Intensiva 2015; 25:212-7. [PMID: 24213084 PMCID: PMC4031850 DOI: 10.5935/0103-507x.20130037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 09/05/2013] [Indexed: 11/20/2022] Open
Abstract
Objective To investigate the association between the rapid shallow breathing index and
successful extubation in patients with traumatic brain injury. Methods This study was a prospective study conducted in patients with traumatic brain
injury of both genders who underwent mechanical ventilation for at least two days
and who passed a spontaneous breathing trial. The minute volume and respiratory
rate were measured using a ventilometer, and the data were used to calculate the
rapid shallow breathing index (respiratory rate/tidal volume). The dependent
variable was the extubation outcome: reintubation after up to 48 hours (extubation
failure) or not (extubation success). The independent variable was the rapid
shallow breathing index measured after a successful spontaneous breathing trial.
Results The sample comprised 119 individuals, including 111 (93.3%) males. The average age
of the sample was 35.0±12.9 years old. The average duration of mechanical
ventilation was 8.1±3.6 days. A total of 104 (87.4%) participants achieved
successful extubation. No association was found between the rapid shallow
breathing index and extubation success. Conclusion The rapid shallow breathing index was not associated with successful extubation in
patients with traumatic brain injury.
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Condessa RL, Brauner JS, Saul AL, Baptista M, Silva ACT, Vieira SRR. Inspiratory muscle training did not accelerate weaning from mechanical ventilation but did improve tidal volume and maximal respiratory pressures: a randomised trial. J Physiother 2013; 59:101-7. [PMID: 23663795 DOI: 10.1016/s1836-9553(13)70162-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
QUESTION Does inspiratory muscle training accelerate weaning from mechanical ventilation? Does it improve respiratory muscle strength, tidal volume, and the rapid shallow breathing index? DESIGN Randomised trial with concealed allocation and intention-to-treat analysis. PARTICIPANTS 92 patients receiving pressure support ventilation were included in the study and followed up until extubation, tracheostomy, or death. INTERVENTION The experimental group received usual care and inspiratory muscle training using a threshold device, with a load of 40% of their maximal inspiratory pressure with a regimen of 5 sets of 10 breaths, twice a day, 7 days a week. The control group received usual care only. OUTCOME MEASURES The primary outcome was the duration of the weaning period. The secondary outcomes were the changes in respiratory muscle strength, tidal volume, and the rapid shallow breathing index. RESULTS Although the weaning period was a mean of 8 hours shorter in the experimental group, this difference was not statistically significant (95% CI -16 to 32). Maximal inspiratory and expiratory pressures increased in the experimental group and decreased in the control group, with significant mean differences of 10cmH2O (95% CI 5 to 15) and 8cmH2O (95% CI 2 to 13), respectively. The tidal volume also increased in the experimental group and decreased in the control group (mean difference 72 ml, 95% CI 17 to 128). The rapid shallow breathing index did not differ significantly between the groups. CONCLUSION Inspiratory muscle training did not shorten the weaning period significantly but it increased respiratory muscle strength and tidal volume.
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Affiliation(s)
- Robledo L Condessa
- Division of Critical Care Medicine, Hospital de Clínicas de Porto Alegre, Brazil.
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Buchan CA, Bravi A, Seely AJE. Variability Analysis and the Diagnosis, Management, and Treatment of Sepsis. Curr Infect Dis Rep 2012; 14:512-21. [DOI: 10.1007/s11908-012-0282-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Abstract
PURPOSE OF REVIEW Liberation from mechanical ventilation is a defining moment for intubated patients, and thus a critical clinical decision. Extubating the patient too early exposes the patient to extubation failure and reintubation. Waiting too long increases the complications of prolonged intubation. Tools to help the physician with this critical decision and to test readiness have been available for decades, and are continuously being improved. New methods to improve extubation outcomes are also being developed. This review covers the latest studies in order to help physicians take advantage of the latest developments in a rapidly evolving field. RECENT FINDINGS This review highlights the recent advances in assessing and testing for readiness of weaning and liberation from mechanical ventilation, the cause of weaning failure, the value of weaning protocols, and the role of noninvasive positive pressure ventilation in liberating patients from invasive mechanical ventilation. SUMMARY Recent findings are shedding more light on this topic, and transforming 'the artistic' aspect of weaning and liberation from mechanical ventilation into a more 'scientific' approach that will expedite liberation from mechanical ventilation yet without encountering high failure rates, and without exposing patients to unnecessary risks.
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Adams RC, Gunter OL, Wisler JR, Whitmill ML, Cipolla J, Lindsey DE, Stehly C, Steinberg SM, Cook CH, Stawicki SP. Dynamic Changes in Respiratory Frequency/Tidal Volume May Predict Failures of Ventilatory Liberation in Patients on Prolonged Mechanical Ventilation and Normal Preliberation Respiratory Frequency/Tidal Volume Values. Am Surg 2012. [DOI: 10.1177/000313481207800138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Rapid shallow breathing index (RSBI, respiratory frequency [f] divided by tidal volume [Vt]) has been used to prognosticate liberation from mechanical ventilation (LMV). We hypothesize that dynamic changes in RSBI predict failed LMV better than isolated RSBI measurements. We conducted a retrospective study of patients who were mechanically ventilated (MV) for longer than 72 hours. Failed LMV was defined as need for reinstitution of MV within 48 hours post-LMV. Ventilatory frequency (f) and Vt (liters) were serially recorded. The instantaneous RSBI (i-RSBI) was defined as f/Vt. Dynamic f/Vt ratio (d-RSBI) was defined as the ratio between two consecutive i-RSBI (f/Vt) measurements ([f2/Vt2]/[f1/Vt1]). RSBI Product (RSB-P) was defined as (i-RSBI 3 d-RSBI). Data from 32 patients were analyzed (Acute Physiology and Chronic Health Evaluation II 13.4, male 69%, mean age 57 years). Mean length of stay was 19.5 days (11.5 ventilator; 14.1 intensive care unit days). For LMV failures, mean time to reinstitution of invasive MV was 20.8 hours. All patients had pre-LMV i-RSBI less than 100. Failed LMVs had higher i-RSBI values (68.9, n = 18) than successful LMVs (44.2, n = 23, P < 0.01). Failures had higher d-RSBI (1.48) than successful LMVs (1.05, P < 0.04). The RSB-P was higher for failed LMVs (118) than for successful LMVs (48.8, P < 0.01) with failures having larger proportion of pre-LMV d-RSBI values greater than 1.5 (39.0 vs 10.7%, P < 0.03). Pre-LMV RSB-P may offer early prediction of failed LMV in patients on MV for longer than 72 hours despite normal pre-LMV i-RSBI. Divergence between RSB-P for successful and failed LMVs occurred earlier than i-RSBI divergence with a greater proportion of pre-LMV d-RSBI greater than 1.5 among failures.
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Affiliation(s)
- Raeanna C. Adams
- Department of Surgery, Division of Trauma & Surgical Critical Care, Vanderbilt, University Medical Center, Nashville, Tennessee
| | - Oliver L. Gunter
- Department of Surgery, Division of Trauma & Surgical Critical Care, Vanderbilt, University Medical Center, Nashville, Tennessee
| | - Jonathan R. Wisler
- Department of Surgery, Division of Critical Care, Trauma, and Burn, The Ohio State University Medical Center, Columbus, Ohio
| | - Melissa L. Whitmill
- Department of Surgery, Division of Critical Care, Trauma, and Burn, The Ohio State University Medical Center, Columbus, Ohio
| | - James Cipolla
- St. Luke's, Regional Level I Trauma Center, Bethlehem, Pennsylvania
| | - David E. Lindsey
- Department of Surgery, Division of Critical Care, Trauma, and Burn, The Ohio State University Medical Center, Columbus, Ohio
| | - Christy Stehly
- St. Luke's, Regional Level I Trauma Center, Bethlehem, Pennsylvania
| | - Steven M. Steinberg
- Department of Surgery, Division of Critical Care, Trauma, and Burn, The Ohio State University Medical Center, Columbus, Ohio
| | - Charles H. Cook
- Department of Surgery, Division of Critical Care, Trauma, and Burn, The Ohio State University Medical Center, Columbus, Ohio
| | - Stanislaw P.A. Stawicki
- Department of Surgery, Division of Critical Care, Trauma, and Burn, The Ohio State University Medical Center, Columbus, Ohio
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Rolim JFC, Moraes NHLD, Uchôa Junior JR. Variáveis hemodinâmicas, hemogasométricas e respiratórias em pacientes cardiopatas submetidos ao teste de respiração espontânea. FISIOTERAPIA EM MOVIMENTO 2011. [DOI: 10.1590/s0103-51502011000400011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
CONTEXTUALIZAÇÃO: Apesar de existirem situações em que há necessidade da ventilação mecânica (AVM), sua retirada (desmame) deve ocorrer tão breve quanto possível, sendo o teste de respiração espontânea (TRE) uma ferramenta útil para abreviar e reduzir os riscos. Existem diversas formas de realizar o TRE, porém, em pacientes cardiopatas, o mais eficaz parece ser associado à pressão de suporte (PSV) e à pressão positiva no final da expiração (PEEP). OBJETIVO: Analisar, ao início e ao término do TRE no modo PSV, o comportamento das variáveis hemodinâmicas, hemogasométricas e respiratórias em pacientes cardiopatas. MÉTODO: 22 pacientes cardiopatas foram submetidos ao TRE por 30 minutos, dos quais cinco foram excluídos e 17 conseguiram concluir o teste. Para mensuração da força muscular inspiratória e da mecânica respiratória, avaliou-se imediatamente antes do TRE: pressão inspiratória inicial e inspiratória máxima, resistência das vias aéreas, complacência estática e dinâmica seguida da avaliação do volume corrente, frequência respiratória, parâmetros hemodinâmicos e hemogasométricos. Todos os parâmetros foram reavaliados 30 minutos após o TRE. RESULTADOS: Os valores tratados na análise estatística dessas variáveis não apresentaram diferença significativa, apenas o índice de desmame ventilatório mostrou variação significativa (p = 0,011). CONCLUSÃO: Por meio do presente estudo, percebeu-se que a maior parte dos pacientes cardiopatas submetidos ao TRE utilizando PSV manteve-se em estabilidade hemodinâmica, hemogasométrica e respiratória. Além disso, percebeu-se que cerca de 82% obteve sucesso ao desmame, sugerindo que PSV é um método seguro e eficaz na interrupção AVM. Contudo, por causa da amostra reduzida, o desenvolvimento de estudos semelhantes torna-se necessário.
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Liu Y, Wei LQ. Increases in B-type natriuretic peptide for detecting weaning-induced heart failure: hidden biases and methodologic flaws in an observational study. Intensive Care Med 2011; 38:172-3; author reply 174. [PMID: 22124772 DOI: 10.1007/s00134-011-2423-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2011] [Indexed: 11/25/2022]
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Increases in B-type natriuretic peptide for detecting weaning-induced heart failure: reply to Liu et al. Intensive Care Med 2011. [DOI: 10.1007/s00134-011-2426-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Savi A, Teixeira C, Silva JM, Borges LG, Pereira PA, Pinto KB, Gehm F, Moreira FC, Wickert R, Trevisan CBE, Maccari JG, Oliveira RP, Vieira SRR. Weaning predictors do not predict extubation failure in simple-to-wean patients. J Crit Care 2011; 27:221.e1-8. [PMID: 21958979 DOI: 10.1016/j.jcrc.2011.07.079] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 06/29/2011] [Accepted: 07/17/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Predictor indexes are often included in weaning protocols and may help the intensive care unit (ICU) staff to reach expected weaning outcome in patients on mechanical ventilation. OBJECTIVE The objective of this study is to evaluate the potential of weaning predictors during extubation. DESIGN This is a prospective clinical study. SETTINGS The study was conducted in 3 medical-surgical ICUs. PATIENTS Five hundred consecutive unselected patients ventilated for more than 48 hours were included. METHODS AND MEASUREMENTS All patients were extubated after 30 minutes of successful spontaneous breathing trial and followed up for 48 hours. The protocol evaluated hemodynamics, ventilation parameters, arterial blood gases, and the weaning indexes frequency to tidal volume ratio; compliance, respiratory rate, oxygenation, and pressure; maximal inspiratory pressure; maximal expiratory pressure; Pao(2)/fraction of inspired oxygen; respiratory frequency; and tidal volume during mechanical ventilation and in the 1st and 30th minute of spontaneous breathing trial. RESULTS Reintubation rate was 22.8%, and intensive care mortality was higher in the reintubation group (10% vs 31%; P < .0001). The areas under the receiver operating characteristic curve showed that tests did not discriminate which patients could tolerate extubation. CONCLUSION Usual weaning indexes are poor predictors for extubation outcome in the overall ICU population.
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Affiliation(s)
- Augusto Savi
- Intensive Care Unit of Moinhos de Vento Hospital, Porto Alegre, Rua Ramiro Barcelos 910, Brazil.
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Su KC, Tsai CC, Chou KT, Lu CC, Liu YY, Chen CS, Wu YC, Lee YC, Perng DW. Spontaneous breathing trial needs to be prolonged in critically ill and older patients requiring mechanical ventilation. J Crit Care 2011; 27:324.e1-7. [PMID: 21798702 DOI: 10.1016/j.jcrc.2011.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 05/31/2011] [Accepted: 06/09/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate a modified weaning procedure to predict extubation outcome in critically older and ventilated patients. METHODS We retrospectively analyzed extubation outcome in older (≥ 70 years) and ventilated patients. In period I (2007), patients passing a 2-hour spontaneous breathing trial (SBT) were extubated. In period II (2008), patients underwent an 8-hour SBT on day 1 and a 2-hour SBT, followed by extubation on day 2. Weaning parameters were recorded at baseline (T(0)) (periods I and II), 2 and 8 (T(8)) hours after SBT (period II). RESULTS The demographic data of patients in each period (n = 64 and 67, respectively) were similar. Patients in period II demonstrated a higher rate of SBT failure but a significantly lower rate of extubation failure and reintubation mortality. In period II, successfully extubated patients demonstrated a significantly lower value of rapid shallow breathing index (RSBI) at T(8). The ratio of RSBI at T(8) over T(0) (T(8)/T(0) ≤ 1.4) demonstrated good diagnostic value (sensitivity 89.5%, specificity 80.0%, accuracy 88.4%) in predicting successful extubation. CONCLUSIONS For critically older and ventilated patients, a prolonged SBT in conjunction with evolution of the RSBI ratio over baseline during SBT may serve as a useful procedure to predict extubation outcome.
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Affiliation(s)
- Kang-Cheng Su
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei City, 112 Taiwan
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Antonelli M, Azoulay E, Bonten M, Chastre J, Citerio G, Conti G, De Backer D, Gerlach H, Hedenstierna G, Joannidis M, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Preiser JC, Pugin J, Wernerman J, Zhang H. Year in review in Intensive Care Medicine 2010: III. ARDS and ALI, mechanical ventilation, noninvasive ventilation, weaning, endotracheal intubation, lung ultrasound and paediatrics. Intensive Care Med 2011; 37:394-410. [PMID: 21290103 PMCID: PMC3042109 DOI: 10.1007/s00134-011-2136-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 01/19/2011] [Indexed: 01/10/2023]
Affiliation(s)
- Massimo Antonelli
- Department of Intensive Care and Anesthesiology, Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy.
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Liu Y, Wei LQ, Li GQ, Lv FY, Wang H, Zhang YH, Cao WL. A Decision-Tree Model for Predicting Extubation Outcome in Elderly Patients After a Successful Spontaneous Breathing Trial. Anesth Analg 2010; 111:1211-8. [DOI: 10.1213/ane.0b013e3181f4e82e] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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